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Billing 5-FU for continuous infusion pump

Kerri Posted Mon 20th of September, 2010 10:04:51 AM

If a patient receives continous infusion 5-FU (J9190), with the loading dose given as a push in the office and then the larger does put in the infusion pump, can we lump the two doses together under the push administration with a note to say what was given in the office and what portion was sent home in the pump with the patient? We have been billing these seperately and have gotten denials for duplicates, even though we are putting the dose that is put in the pump on a seperate ticket with the location of home and a modifier to indicate that the drug was put in the pump for home use. Is anyone else having this same problem?

SuperCoder Answered Tue 21st of September, 2010 13:13:51 PM

There are certain criteria that has to be followed while administrating these drugs they are:
# Parenteral administration of the drug in the home is reasonable and necessary.
# An infusion pump is necessary to safely administer the drug.
# The drug is administered by a prolonged infusion of at least 8 hours because of proven improved clinical efficacy.
The drug is administered by intermittent infusion (each episode of infusion lasting less than 8 hours) which does not require the patient to return to the physician's office prior to the beginning of each infusion.
# The therapeutic regimen is proven or generally accepted to have significant advantages over intermittent bolus administration regimens or infusions lasting less than 8 hours.
Systemic toxicity or adverse effects of the drug is unavoidable without infusing it at a strictly controlled rate as indicated in the Physicians Desk Reference, or the U.S. Pharmacopeia Drug Information.

A proper documentation of the agent, route, dose given, and the duration of administration must be in the medical record, which has to be provided on request.
To know more visit the cms.gov for the coverage criteria and policies.

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